Director, Case Management

Position: Director of Case Management

Location: Boston Medical Center - South (Brockton, MA)

Schedule: Full Time

POSITION SUMMARY :

The Director of Care Management and Inpatient Social Work Services shall oversee the overall operations of Care Management functions through oversight of both daily and long term activities at Boston Medical Center – South including supervision of a team of RN Case Managers, Social Worker MSWs, and a Program Manager for Case Management. In this capacity, the Director is responsible for developing and supporting systems and processes for care/utilization management in collaboration with the BMC Main Campus, and managing the department's activities related to discharge planning and clinical quality improvement.

ESSENTIAL RESPONSIBILITIES / DUTIES:

• With a focus on reducing length of stay, minimizing readmissions and appropriate level of care assignment - establishes, implements, evaluates, and communicates a strategic plan for the department that takes into account internal and external factors. 

• Creates data priorities and report formats that display critical outcome factors, and reviews findings with the Executive Team. 

• Establishes appropriate staffing levels, assignments, and deployment for the department. 

• Establishes job descriptions and performance criteria for staff members. 

• Identifies organizational needs and concerns in payer-provider contracts and contributes to related negotiations. 

• Establishes effective relationships with individual physicians, physician groups, and physician organizational structures. 

• Develops structures and processes to facilitate participation by physicians, pharmacists, nurses, social workers, and other health professionals in multidisciplinary care planning, care delivery, and discharge planning. 

• Develops, leads, and implements an effective outcomes management process. 

• Establishes effective relationships with external agencies providing services to the organization (such as vendors, care providers, etc.). 

• Evaluates and optimizes patient satisfaction with discharge planning functions. 

• Supports utilization review activities for the hospital, interfacing with the BMC Main campus utilization review program, external payers and review companies to support determination of appropriate medical necessity of admissions and continued hospitalization. 

• Resolves conflicts related to discharge planning with patients/families, external agencies, and payers. 

• Facilitates transition of patients/families across the continuum by establishing relationships with appropriate post-acute providers and community services. 

• Provides leadership to multidisciplinary groups as organized by the facility. 

• On an annual basis, develops measurable, reasonable, and market-oriented goals for the department that reflect those of BMC-South and the Case Management department. 

• Establishes policies, procedures, and protocols for departmental functions. 

• In collaboration with BMC Main campus, assists with insuring that the Utilization Management process is current. 

• Ensures that the Discharge Planning process is current. 

• Creates processes to anticipate and address specific situations within the department, including long-stay patients, post-acute resource referral lists, denials, and termination of benefits. 

• Identifies improvement opportunities within the department and at the system level. 

• Creates a system for initial and ongoing education and development of staff. 

• Ensures compliance with The Joint Commission standards and CMS rules and regulations .

(The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job. The above is not intended to represent an exhaustive list of accountable duties and responsibilities required)

JOB REQUIREMENTS

REQUIRED EDUCATION AND EXPERIENCE:

• BSN and 7 to 9 years of experience, or equivalent combination of education and experience, required.

PREFERRED EDUCATION AND EXPERIENCE:

• MSN preferred

CERTIFICATIONS, LICENSES, REGISTRATIONS REQUIRED:

• MA RN Licensure 

CERTIFICATIONS, LICENSES, REGISTRATIONS PREFERRED:

• N/A

KNOWLEDGE, SKILLS & ABILITIES (KSAs):

• Knowledge of payer requirements and discharge planning regulations that support the effective development of departmental policies, procedures, and standards. 

• Demonstrated ability to establish the goals, vision, and overall direction of a department; create and implement departmental standards, systems, staffing plan, and processes; analyze issues and create an effective plan to address them; critically and comprehensively evaluate the department’s outcomes; identify, collect, and analyze data related to the internal and external environment as well as departmental functioning; and develop and educate staff. 

• Demonstrated ability to communicate verbally and in writing to internal and external constituencies. 

• Ability to establish priorities, meets deadlines, and develop and manage the department’s productivity standard in the management of the work assignment. 

• Ability to form positive, collaborative relationships with members of the executive team, hospital staff, post-acute providers, and payers. 

• Ability to problem-solve in a proactive, creative manner, using sound judgment based on information and clinical knowledge. 

• Ability to effectively negotiate with internal and external service providers.

• Knowledge of external requirements that impact the department, such as The Joint Commission and Department of Health. 

• Knowledge of information systems to support the evaluation of current capacity as well as future needs. 

• Extensive knowledge and comfort with Interqual criteria

Compensation Range:

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensures as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, BMCHS offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), discretionary annual bonuses and merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family well-being.

NOTE : This range is based on Boston-area data, and is subject to modification based on geographic location.

Equal Opportunity Employer/Disabled/Veterans

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